Hair Loss

Hair Loss Overview

The loss of hair (alopecia) is a natural phenomenon in all hair-baring animals that normally occurs during the hair growth cycle. It is estimated that most individuals (assuming they have a full head of hair) lose about 100 scalp hairs over a 24-hour period. Hair loss can become a cosmetic problem when it occurs in the wrong place at the wrong time in the wrong individual. True hair loss should be distinguished from damage to the hair shaft, which may cause breakage close to the scalp. This sort of damage is most often caused by exogenous chemicals used to alter the physical characteristics of the hair shaft (hair dye, etc.), but certain genetic diseases can alter its strength and durability.

* Physicians divide cosmetically significant hair loss into two categories.


1. Scarring alopecia: This sort of irreversible hair loss is characterized by damage to the underlying skin which results in scarring that destroys the hair follicle and its potential for regeneration. A simple visual examination is usually sufficient to diagnose this problem, although occasionally a biopsy may be necessary. Certain skin diseases as well as physical trauma produce this sort of damage.

2. Non-scarring alopecia: This potentially reversible type of hair loss is very common and can be due to many causes, including certain diseases, drugs, aging, diet, as well as a genetic predisposition for hair loss called androgenetic alopecia (common balding).

* There are three cycles of hair growth: growing (80% of follicles), resting, and shedding. In human hair, each follicle cycles at its own individual rate as opposed to most animals, where these cycles change with the season, and all hairs are in the same part of the cycle at the same time. This is why animals grow a thicker coat in the fall and shed most in the spring and why human beings do not shed.


o Unlike most animals, in humans, each hair has its own pattern of growing, resting, and shedding.


+ Each person sheds hair and regrows hair every day.


+ When this balance is disturbed and more hairs are shed than are regrown, alopecia or hair loss results.

Hair Loss Causes

* Common causes of hair loss


o Male-pattern baldness, a non-scarring alopecia (androgenetic alopecia), is genetically determined. In afflicted postpubertal individuals, hair follicles in the center of the scalp and over the temple begin to miniaturize, producing small, fine hairs which are difficult to see. This process is due to the metabolism of testosterone by an enzyme in the hair follicle. Generally, hair follicles over the ears and around the posterior of the scalp do not possess this enzyme so a fringe of normal hair is maintained.


o Female-pattern baldness is very similar to its male counterpart although it is rarely as complete, more diffuse, and often a frontal hairline is maintained.


o Alopecia areata, a non-scarring alopecia, is thought to be an autoimmune disease and is characterized by distinct, localized, sharply marginated areas of hair loss. This characteristically spontaneously remits but occasionally can result in the loss of 100% of all body hair.


o Medications such as allopurinol (Zyloprim) and warfarin (Coumadin)


o Poor nutrition


* Uncommon causes of alopecia


o Infections such as syphilis and fungal infections


o Skin diseases such as lupus and lichen planus


o Skin cancers


o Hormone problems


o Kidney failure


o Liver failure


o Thyroid disease


Hair Loss Symptoms and Signs

* Most people notice hair loss when looking at themselves in a mirror or when it is brought to their attention by others.


* You may also find many hairs on your pillow in the morning or in your hairbrush or comb.


* A woman may notice a decrease in the size of her ponytail or the widening of her part.

Hair Loss Treatment

If hair loss is caused by an illness, treatment of the illness is the best treatment for hair loss. The decision to treat androgenetic alopecia depends upon its emotional effect on the patient's sense of well-being. Many different therapies to stop hair loss and to regrow hair are promoted; you should discuss these options with your physician to establish their validity.

Treatment options include grooming techniques, wigs and hairpieces, medications, and surgery.

* Styling hair to cover the areas with the most hair loss is effective for mild cases. Washing and styling the hair will not cause further hair loss.


* For more severe hair loss, wigs and hairpieces can provide good results if you are willing to try them. Either of these options can be used in combination with medications or surgery if the results of styling or the hairpiece alone are not satisfying.

Medical Treatment

Androgenetic alopecia

* Finasteride (Propecia): a pill taken once daily that blocks the activity of an enzyme that metabolizes testosterone to substance that inhibits hair growth. Any regrowth is not permanent. Finasteride is not currently used for the treatment of hair loss in women.


* Minoxidil (Rogaine, Loniten): A medication you rub directly onto your scalp. This medication enlarges hairs and makes them grow for a longer period.


o It works for both men and women.


o It works best for balding at the top and back of the head and less well for the front area of the scalp.


o Stopping this medication can result in loss of the hair that developed during its use.

Alopecia areata

Intralesional injection of steroids directly into the areas of involved skin can mitigate the hair loss for a short period of time.

Hair Loss Prevention

Prevention can be accomplished only by early treatment. Sometimes what you think may be hair loss is actually just hair breakage from overuse of hair dryers, curling irons, dyes, and styling products.